- Molina Healthcare (Mesa, AZ)
- …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Banner Health (Phoenix, AZ)
- …delivery, focusing on value-based care, risk recapture, and quality outcomes. This role includes medical case review , utilization , and quality review , ... an environment of quality care and efficiency + Conduct medical case reviews, utilization and quality assessments,...and efficiency + Conduct medical case reviews, utilization and quality assessments, and make strategic recommendations for… more
- Molina Healthcare (Phoenix, AZ)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… more
- CVS Health (Phoenix, AZ)
- …in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
- Molina Healthcare (Phoenix, AZ)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... for the state they reside This position will support Medical Review for Medicare and Marketplace request...be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and… more
- CenterWell (Phoenix, AZ)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Phoenix, AZ)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Evolent (Phoenix, AZ)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Centene Corporation (Phoenix, AZ)
- …on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken… more